Background
An abdominal aortic aneurysm is a common degenerative condition involving
the major blood vessel supplying the lower body and legs. As seen
in the diagram, the aorta gives off two branches, one to each leg
(iliac arteries). An abdominal aortic aneurysm may also involve one
or both of these iliac arteries. Some abdominal aortic aneurysm have
a hereditary component so if another family member has an abdominal
aortic aneurysm, screening should be considered.
Natural history of Abdominal Aortic Aneurysm
Abdominal aortic aneurysm tends to grow over period of years and
do not often arise suddenly. The average growth rate is about 0.5
cm a year, but some abdominal aortic aneurysms grow fatter. Once
an abdominal aortic aneurysm reaches 5-6cm in diameter, the risk
of rupture increases significantly. If rupture occurs, only about
50% of patients survive an emergency operation. This is a very serious
condition.
Symptoms
Most abdominal aortic aneurysms produce no symptoms at all and are
found on routine physical examination or on routine x-rays. Those
that cause symptoms are of great concern. Common symptoms that might
be described are: back pain abdominal pain flank pain
Diagnostic Testing
Once an abdominal aortic aneurysm is found, an ultrasound or cat
scan is usually ordered to verify the size of the abdominal aortic
aneurysm. On occasion, an aortogram (angiogram or arteriogram) may
be necessary. If surgery is necessary, other blood tests and consultation
may be ordered.
Treatment Options
Fortunately treatment exists to prevent abdominal aortic aneurysm
rupture and cure the problem of abdominal aortic aneurysm. Abdominal
aortic aneurysm surgery is an established procedure with a long
track record of success. Most procedures are done through an incision
in the left side of the abdomen and the artificial graft that replaces
the aneurysm is sewn in place so movement will not occur. Hospitalization
averages 4 days. Once the post-operative phase is over, there is
no need for routine follow up care.
Angiogram of aortic aneurysm
This
is the same patient seen above, now after an aortic stent
was placed.
Aortic stent procedures (endografts) have more recently been introduced
as a less invasive method of aneurysm repair. This procedure is
done in the operating room and two groin incisions are necessary.
A stent with an artificial graft is placed through the aneurysm
and is anchored to the wall of the aorta with radial force instead
of sutures. An overnight stay in the hospital is necessary. Routine
follow-up is necessary for the rest of the patient's life so that
any stent movement or complication is identified as soon as possible.
This procedure is more commonly used for higher risk patients with
favorable aneurysm anatomy and is definitely not for everyone.
Post Operative care
The management of patients after surgery
is a joint effort between the doctors and the nurses. Comprehensive
management of postoperative discomfort increases the chances of
a quick recovery. Once a patient is discharged, he/she can expect
to need about a month to regain full stamina and endurance.
